From the Guidelines
When a patient dies, the medical examiner typically starts the case, especially in situations where the death is sudden, unexpected, violent, suspicious, or occurs without recent medical attention. This is because the medical examiner has the legal authority to investigate such cases, perform autopsies, and determine the cause and manner of death 1. In contrast, if a patient dies from a known natural disease process while under a doctor's care, the primary care physician (PCP) can typically certify the death by completing the death certificate. Key factors that determine whether the medical examiner or PCP is involved include:
- The circumstances of death, such as whether it was sudden, unexpected, or suspicious
- Whether the patient was under a doctor's care at the time of death
- State and local laws regarding which deaths must be reported to the medical examiner According to the American Academy of Pediatrics, ED procedures should include identification and notification of the medical examiner/coroner regarding all deaths, as directed by applicable law 1. Additionally, the medical home and primary care provider should be coordinated with in follow-up of any postmortem examination, highlighting the importance of collaboration between healthcare providers in the event of a patient's death 1. In real-life clinical practice, it is essential to be familiar with the regulations in your jurisdiction to ensure that deaths are reported and handled appropriately.
From the Research
Investigation of Death
When a patient dies, the investigation of the death is typically started by the medical examiner or coroner, not the primary care physician (PCP).
- The medical examiner or coroner is responsible for investigating deaths, including determining the cause and manner of death 2.
- The investigation requires attention to detail at the time of scene investigation and autopsy examination, as well as a careful assessment of the toxicologic results and circumstances of the death.
- The medical examiner or coroner synthesizes the many facts developed during the investigation to establish a reasonable cause of death.
Role of the Medical Examiner
The medical examiner plays a crucial role in investigating deaths, including:
- Conducting autopsies and analyzing toxicology results to determine the cause and manner of death 3, 4.
- Considering the circumstances surrounding the death, including the medical and drug use history of the deceased person 5.
- Interpreting analytical results, taking into account potential postmortem changes and limitations of the analysis 6.
Postmortem Toxicology
Postmortem toxicology is an essential part of death investigations, as it helps determine whether foreign substances were a cause of death, contributed to death, or caused impairment.
- Toxicological analyses are used to identify the presence and concentration of drugs and other substances in the body 3, 4.
- The interpretation of toxicology results requires careful consideration of various factors, including the circumstances of the death, the medical history of the deceased, and potential postmortem changes 5, 6.